Job Description

Authorization Specialist

Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and capability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full time Authorization Specialist.
POSITION SUMMARY
Responsible for screening request for prior-authorization. Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost effective and appropriate healthcare delivery. Obtains Authorizations under the supervision of the Director of Managed Care and the VP of Managed Care according to departmental guidelines. Per standard workflows, forwards specified requests to the managed care company for review and processing.
ESSENTIAL FUNCTIONS

»Prioritizes incoming Prior Authorization requests.

»Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines.

»Refers any managed care requests that need additional clinical information to ADHC/RHCF or Primary Care Program Director.

»Verifies member eligibility via epaces and enters information in Managed Care repository.

»Identifies and informs managed care department and care providers of any insurance service changes and or benefits available to member.

»Informs care provider and Managed Care Department of authorization decisions made by managed care plan per department procedures.

»Coordinates resolution of escalated member or provider inquiries as related to Prior Authorization.

»Works with members, providers and key departments to promote an knowledge of Prior Authorization requirements and processes.

»Supports managed care group in following up on request for Authorization or denial notifications.

»Tactfully handle telephone communications with Brightpoint Health Staff, and Outside Manage Care Organizations

»Clerical task will include but are not limited to data entry, faxing, filing, copying, scanning and report distribution.

»Assist with various projects as needed utilizing agency software and Microsoft applications including Excel, Word and Outlook.

»Assists Credentialing Specialist with provider credentialing related tasks as requested.
MINIMUM EDUCATION REQUIREMENT:

»High School Diploma
Preferred suitable education Associates Degree
Minimum Related Work practice: 1 year
Hourly Range: $17.25 - $19.00 p/h

Job Tags

Hourly pay, Full time

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